Patton Carla, Stiltner Denise, Wright Kelly Barnhardt, Kautz Donald D
Catawba Valley Medical Center, Hickory, North Carolina (Mss Patton, Stiltner, and Wright); and University of North Carolina Greensboro Greensboro (Dr Kautz).
Adv Neonatal Care. 2015 Feb;15(1):8-22. doi: 10.1097/ANC.0000000000000145.
Sudden infant death syndrome (SIDS) may be the most preventable cause of death for infants 0 to 6 months of age. The American Academy of Pediatrics (AAP) first published safe sleep recommendations for parents and healthcare professionals in 1992. In 1994, new guidelines were published and they became known as the "Back to Sleep" campaign. After this, a noticeable decline occurred in infant deaths from SIDS. However, this number seems to have plateaued with no continuing significant improvements in infant deaths.
The objective of this review was to determine whether nurses provide a safe sleep environment for infants in the hospital setting. Research studies that dealt with nursing behaviors and nursing knowledge in the hospital setting were included in the review.
A search was conducted of Google Scholar, CINAHL, PubMed, and Cochrane, using the key words "NICU," "newborn," "SIDS," "safe sleep environment," "nurse," "education," "supine sleep," "prone sleep," "safe sleep," "special care nursery," "hospital policy for safe sleep," "research," "premature," "knowledge," "practice," "health care professionals," and "parents."
The review included research reports on nursing knowledge and behaviors as well as parental knowledge obtained through education and role modeling of nursing staff. Only research studies were included to ensure that our analysis was based on rigorous research-based findings. Several international studies were included because they mirrored findings noted in the United States. All studies were published between 1999 and 2012.
Healthcare professionals and parents were included in the studies. They were primarily self-report surveys, designed to determine what nurses, other healthcare professionals, and parents knew or had been taught about SIDS.
Integrative review.
Thirteen of the 16 studies included in the review found that some nurses and some mothers continued to use nonsupine positioning. Four of the 16 studies discussed nursing knowledge and noncompliance with AAP safe sleep recommendations. Eleven of the 16 studies found that some nurses were recommending incorrect sleep positions to mothers. Five of the 16 studies noted that some nurses and mothers gave fear of aspiration as the reason they chose to use a nonsupine sleep position.
In the majority of the studies, the information was self-reported, which could impact the validity of the findings. Also, the studies used convenience sampling, which makes study findings difficult to generalize.
The research indicates that there has been a plateau in safe sleeping practices in the hospital setting. Some infants continue to be placed in positions that increase the risk for SIDS. The research also shows that some nurses are not following the 2011 AAP recommendations for a safe sleep environment. Clearly, nurses need additional education on SIDS prevention and the safe sleep environment, and additional measures need to be adopted to ensure that all nurses and all families understand the research supporting the AAP recommendation that supine sleep is best. Further work is needed to promote evidence-based practice among healthcare professionals and families.
婴儿猝死综合征（SIDS）可能是0至6个月大婴儿最可预防的死因。美国儿科学会（AAP）于1992年首次为家长和医护人员发布了安全睡眠建议。1994年，新的指南发布，它们被称为“仰睡”运动。此后，SIDS导致的婴儿死亡人数显著下降。然而，这一数字似乎已趋于平稳，婴儿死亡人数没有持续显著改善。
本综述的目的是确定护士在医院环境中是否为婴儿提供了安全的睡眠环境。本综述纳入了涉及医院环境中护理行为和护理知识的研究。
使用关键词“新生儿重症监护病房（NICU）”、“新生儿”、“SIDS”、“安全睡眠环境”、“护士”、“教育”、“仰卧睡眠”、“俯卧睡眠”、“安全睡眠”、“特殊护理病房”、“安全睡眠医院政策”、“研究”、“早产”、“知识”、“实践”、“医护人员”和“家长”，在谷歌学术、护理及健康领域数据库（CINAHL）、医学期刊数据库（PubMed）和考科蓝图书馆进行了检索。
本综述纳入了关于护理知识和行为以及通过护理人员的教育和示范获得的家长知识的研究报告。仅纳入研究以确保我们的分析基于严格的基于研究的结果。纳入了几项国际研究，因为它们反映了在美国注意到的结果。所有研究均发表于1999年至2012年之间。
研究纳入了医护人员和家长。它们主要是自我报告调查，旨在确定护士、其他医护人员和家长对SIDS了解或所学的内容。
综合综述。
本综述纳入的16项研究中有13项发现，一些护士和一些母亲继续使用非仰卧姿势。16项研究中有4项讨论了护理知识以及不符合AAP安全睡眠建议的情况。16项研究中有11项发现，一些护士向母亲推荐了不正确的睡眠姿势。16项研究中有5项指出，一些护士和母亲给出的选择非仰卧睡眠姿势原因是担心误吸。
在大多数研究中，信息是自我报告的，这可能影响结果的有效性。此外，研究采用了便利抽样，这使得研究结果难以推广。
研究表明，医院环境中的安全睡眠实践已趋于平稳。一些婴儿继续被放置在增加SIDS风险的姿势中。研究还表明，一些护士未遵循2011年AAP关于安全睡眠环境的建议。显然，护士需要接受关于SIDS预防和安全睡眠环境的额外教育，并且需要采取额外措施以确保所有护士和所有家庭理解支持AAP仰卧睡眠最佳建议的研究。需要进一步开展工作以促进医护人员和家庭中的循证实践。
